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August 7, 2011 'OH MY GOSH! I'M THE DOCTOR'
First-year residents plunge into new roles
By Joey Holleman, THE STATE Newspaper - firstname.lastname@example.org
August 7, 2011
'OH MY GOSH! I'M THE DOCTOR'
In every profession, the first few days on the job can be a confusing blur - learning co-workers' names, wandering new hallways, navigating unfamiliar computer systems.
Toss in working long hours and, oh by the way, making decisions about treating someone else's sick child, and you get a notion of the pressures felt by the first-year pediatric residents at Palmetto Health Children's Hospital. Even though they've had a taste of the routine during medical school, the first few shifts on the job with the title "Dr." in front of their names can be eye-opening for the residents.
"It's like jumping into a cold pool, you just have to do it," said new resident Dr. John Daniel, 26. "But there are plenty of (experienced) people around to help you build your confidence.
"The first time your beeper goes off you think, 'Oh my gosh! I'm the doctor, and I have to answer this.' It's excitement and anticipation."
Daniel is one of 12 pediatric residents at Palmetto Health Children's Hospital selected from a group of 142 recent medical school graduates. Palmetto Health has developed a reputation as a first-rate training ground for pediatrics, with 96 percent of the past three classes passing the national accreditation test at the end of their three years of hospital training. The national average is about 80 percent.
"We choose the right people," said Dr. Caughman Taylor, senior medical director of Palmetto Health Children's Hospital and chairman of the USC School of Medicine's Department of Pediatrics. "I can teach anybody medicine. What I can't teach them is what their mommas taught them."
Traits such as working hard, treating other people with respect and having a good attitude are as important as intelligence, he said. Palmetto Health has a good track record in recruiting residents with those qualities. Taylor said a recruit explained the appeal of Palmetto Health compared to other residency programs the recruit had visited: "Your residents are the ones who smile."
Learning curve goes straight up
The new class of residents arrives each year at the start of July. The newbies lean on second- or third-year residents and the more experienced attending physicians for advice and second opinions, but they are expected to make the initial diagnoses for patients they see.
"The responsibility with writing your first order is both incredibly rewarding and stressful," said first-year resident Dr. Carrie Torr, 27. "You read over it three or four times and then have somebody else check it, too."
During a recent session of teaching rounds, about a dozen people - medical school students, pharmacy school students and hospital residents - filtered into a room around 9:30 a.m. Many brought food and drinks, since this was one of the few times in a long work day they could sit down and eat.
Dr. Matthew Garber, an assistant professor of clinical pediatrics, breezed in and quickly started into the day's lesson by asking "Who has a good case?" The unspoken message was, he was prepared for anything, and his students should be, too.
They spent the next 45 minutes discussing the case of a 30-week-old child with respiratory problems. Garber peppered the students with questions, mixing in the hospital protocols they should know or soon will. Steroid treatment for breathing problems generally doesn't work for children under age 2. Certain drugs are only used in emergency settings. Certain drugs work together well, but only in certain doses.
More tests didn't seem necessary because the patient improved with drug treatment. But at what stage would more tests have been helpful, and at what level are tests overkill?
"It's tough for new doctors," Garber said. "You don't want to do too much, and you don't want to do too little."
Garber pulled from decades of experience to come up with tough questions. When he called on residents around the long table, the residents often didn't know the answers. In a clinical setting, they might go check medical books. One goal of residency is to translate that book knowledge into working knowledge.
Skills are put to work quickly
The new residents also are still learning the nuances of working with patients. While one group of first-years was in teaching rounds, another group was seeing patients in the hospital's clinic next door.
New resident Dr. Becky Polk, 26, already had the bedside manor of an old pro as she talked with a young Hispanic girl and her mother during a well visit to the clinic. The chart indicated the girl had been to the clinic previously with allergy problems.
"Are you having any problems with your allergies?" Polk asked.
The girl said no, and Polk turned to her mother and asked, "Do you agree they're better?"
The mother, who had asked for an interpreter to help with complicated questions, nodded her head yes.
Polk moved on to general health, asking the slightly overweight child what she liked to eat. She urged the girl to eat three meals each day and suggested healthy foods. The young doctor praised the girl for drinking mostly water and low-sugar lemonade.
They talked about school, and Polk smiled when the girl said she makes good grades and wants to be a doctor when she grows up.
"She looks great," Polk said to the mother. "The only thing that concerns me is the weight. You really need to integrate exercise into her daily routine and (as she turned to look at the girl) less TV."
The mother gave the daughter an I-told-you-so glance that also didn't need to be translated.
After the mother and daughter left, Polk recalled her first day on the job a few weeks earlier. For her, pent up nervousness immediately gave way to her quest to learn as much as she could as quickly as she could.
Her first week, she and a third-year resident were examining a child. "The father kept saying 'Listen to the doctor,'" Polk recalled. "It seemed very strange ... because that was me."